Sections A&B
The article by De Vrieze basically indicates that fecal matter has great potential in the treatment of the various numerous diseases that are beset and worsened by infections involving the bacterium C. difficile especially given the identified anecdotal as well as tentative scientific evidence. Despite this potential, however, the use of fecal matter seems to be too much for many people including some healthcare professionals where some are simply biased while others are afraid of potential adverse outcomes that may accompany associated treatments. Still, the acceptance of fecal transplant and the research stream established towards the identification of specific microbial strains responsible for the positive results identified in fecal transplants provides hope of tapping into new treatments.
The potential of fecal transplantation especially as demonstrated by the randomized controlled trial conducted by van Nood et al. seems to be the point of Kelly’s article given the rising recurrence of C. difficile amidst antimicrobial therapy while various studies attest to the greater efficacy of fecal transplant. The case for fecal transplantation seems to already have established precedents even though aversion towards usage of fecal matter for treatment also seems relatively strong even though positive results are likely to bolster more research interests into the phenomena. This includes the targeting and isolation of specific microbial strains responsible for positive results identified in fecal transplants given the potential for healing and preventing illnesses like colorectal carcinoma, among others.
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Section C
The importance of van Nood et al.’s study is that it offers a radicle and more effective approach to elimination of a bacterium that is central to the many rising health-associated infections using feces. The author’s hypothesized that duodenal infusion of donor feces in patients with recurrent Clostridium difficile infection would be a more effective treatment than antibiotic therapy using Vancomycin both with and without bowel lavage. Subjects with a life expectancy of at least 3 months, 18 years and above and a relapse of C. difficile after at least one course of adequate antibiotic therapy (?10 days of vancomycin at a dose of ?125 mg four times per day), were chosen. Further, those with human immunodeficiency virus (HIV) infection (<240 CD4 count), prolonged compromised immunity due to recent chemotherapy, prolonged use of prednisolone (at least 60 mg per day), pregnant, having been admitted to an intensive care unit, using antibiotics other than for treating C. difficile infection at baseline or using vasopressor medication, were excluded. For donors, only those under age 60, with no risk factors for transmissible diseases or whose feces had no parasites, C. difficile, and enteropathogenic bacteria as well as those whose blood was not contaminated by HIV, hepatitis and other viruses, were chosen. As a randomized controlled trial type of experiment, van Nood et al.’s study involved choosing patients at random to receive various clinical interventions including a control (placebo or no intervention). Figure 2 indicates patients that were healed by infusion of donor feces, standard vancomycin therapy as well as with standard vancomycin therapy plus bowel lavage which supports the authors’ hypothesis. Questions regarding the amount of fecal matter required, optimal protocol for donor-feces infusion or the significance of varying potential routes of infusion such as colonoscopy, among others, remain unanswered.
Section D
Given the success rate of what is being referred to as Fecal Microbiota Transplantation (FMT), it is amazing that people, especially those in the healing profession, are biased against the practice considering the implications of FMT on diseases like irritable bowel syndrome, among others. Still, the seriousness of various unanswered questions regarding FMT does indeed necessitate consideration of enhancing FMT before it becomes more widely accepted considering the potential negative outcomes. Nevertheless, the relative acceptance of FMT and the subsequent focus towards the identification of specific microbial strains derived from fecal matter for treating C. difficile highlights a breakthrough that can set a forward pace towards identification of more effective treatments for C. difficile infections.
- De Vrieze, Jop. “The Promise of Poop.” Science 341.6149(30 Aug. 2013): 954-957.
- Kelly, Ciar?n P. “Fecal Microbiota Transplantation – An Old Therapy Comes of Age.” New England Journal of Medicine 368(January 31, 2013): 474-475.
- van Nood, Els et al. “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.” New England Journal of Medicine 368(January 31, 2013): 407-415.
